Women's Preferences for Lifestyle Behaviors in Osteoporotic Fracture Prevention: A Discrete Choice Experiment in China

OBJECTIVES: Postmenopausal women are more vulnerable to osteoporosis and its severe sequelae disproportionately, such as osteoporotic fractures. This study aimed to assess women’s preferences with regard to adopting lifestyle behaviors to prevent osteoporotic fractures.

METHODS: A cross-sectional, nationwide sampling discrete choice experiment (DCE) study was conducted to elicit women’s preference for lifestyle behaviours in osteoporotic fracture prevention. Seven attributes and corresponding levels were determined by literature review, expert consultation and ISPOR guidelines. The sampling performed through various online social platforms from December 2023 to May 2024, covering all provincial administrative regions in China. Respondents were included if they were female, at least 45 years old, and without cognitive impairment. The descriptive analysis, conditional logit model and latent class model were applied for data analyses.

RESULTS: A total of 395 people participated, with 304 valid samples were included in the analysis. More than half of the respondents (53.9%) were aged 45-49, and most of the respondents (82.9%) lived in urban areas. Most respondents (66.8%) did not have osteoporosis or were unsure (24.3%). Preference analysis indicated that physical activity (34%) has the largest utility weight, followed by healthy diet (20%) and fall prevention training (14%). In addition, respondents prefer low-intensity physical activity, 15-30 minutes sunlight, a balanced diet guideline with specific guidance in calcium-rich foods instead of non-specific bone health diet recommendations. Latent class model identified two groups among respondents, respondents in the group prioritize fall prevention training, while those in another group believe that a healthy diet plays a crucial role in preventing osteoporosis.

CONCLUSIONS: Women are willing to engage in moderate physical activity, expose under the sunlight and have healthy diets. Clinicians should engage in a conversation with patients to ensure patients can make informed choices for lifestyle changes that fit their medical needs as well as their preferences and beliefs.